Provider Demographics
NPI:1790705903
Name:GRUNDER, PENNY TOSHIE (RPSGT)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:TOSHIE
Last Name:GRUNDER
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27144 LEVI LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IA
Mailing Address - Zip Code:52768-9711
Mailing Address - Country:US
Mailing Address - Phone:563-940-4306
Mailing Address - Fax:
Practice Address - Street 1:4364 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6867
Practice Address - Country:US
Practice Address - Phone:866-235-6763
Practice Address - Fax:309-762-2919
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic